Headache, vascular

• Cephalalgia
• Headache

• 307.81 Tension headache
• 339 Other headache syndromes
• 339.0 Cluster headaches and other trigeminal autonomic cephalgias
• 339.1 Tension type headache
• 339.2 Post-traumatic headache
• 339.3 Drug-induced headache, not elsewhere classified
• 339.4 Complicated headache syndromes
• 339.8 Other specified headache syndromes

• G43 Migraine
• G44 Other headache syndromes
• G44.009 Cluster headache syndrome, unspecified, not intractable

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

Description

• Pain in the head or neck region
• Severe episodes of intense pain
• Hypersensitivity to light and sound
• Many triggers
• National Institute of Health (NIH): vascular headache is 1 of 4 classifications of headaches2

Essentials of Diagnosis

• ICDH-II (International Classification of Headache Disorders-II)3
  • Considered a secondary headache
• NIH: vascular headaches include
  • Migraine
  • Cluster headaches

General Considerations

• Headaches can be harmless, disabling, or life-threatening.
• Headaches can be a sign of something more severe in the head/brain region.
• Vision problems and sinuses can cause headaches.

Demographics

• Cluster headaches are more common in men
• Migraine headaches are more common in women

Signs and Symptoms

• Differential features of headaches in children
• Migraine
  • Pulsating pain
  • Nausea
  • Sensitivity to light
  • Sensitivity to sound
  • One or both sides of the head
  • Aggravated with routine activity
• Cluster headaches
  • Severe headaches
  • Short lasting
  • Symptoms around the eye

Functional Implications

• Difficulty maintaining sustained sitting postures secondary to neck pain
• Inability to sleep
• Weakness with upper extremity (UE) lifting
• Inability to drive or work secondary to the inability to tolerate light or sound

Possible Contributing Causes

• Forward head, rounded shoulders posture due to tight pectoralis, weak periscapular, and deep neck flexor muscles
• Prolonged position of cervical side bending towards impaired nerve or prolonged extension
• Facet hypertrophy
• Trauma
• Light
• Sounds
• Hydration
• Nutrition deficiency
• Vascular insufficiency
• Muscular tightness
• Stress

Differential Diagnosis

• Tumor
• Glaucoma
• Sinusitis
• Myofascial pain syndrome
• Rhomboid/trapezius spams
• Degenerative disk disease
• Lyme disease
• Temporomandibular joint dysfunction
• Arnold Chiari malformation
• Toxic headaches
• Muscular tension/myogenic headache
• Cervicogenic headache

Imaging

• MRI helpful in diagnosis to visualize the head/brain region
• X-ray/plain film radiograph helpful if osteophyte located in intervertebral foramen in cervical spine
• Doppler blood flow test
• CT

• Physical exam cluster to rule in cervical radiculopathy4
  • Spurlings test
  • Rotation limited to ipsilateral side
  • Upper limb nerve tension test
  • Diminished brachioradialis reflex

• Imaging
• Nutritionist
• Optometrist for an eye exam
• Neurologist
  • Imaging

• Vision
• Hearing
• Restricted mobility of the upper/mid-thoracic spine and subcranial spine
• Hypermobile mid-cervical spine
• Tight pectoralis major and minor
• Weakness noted of longus coli and longus capitus
• Weakness noted of periscapular ...